shutterstock_93685306 The Institute of Medicine in 2010 famously recommended that nurses should be encouraged to practice “to the full extent of their education and training.” Often, you’ll hear people advocate that every health care worker should “practice at the top of their license.” What this concept is supposed to mean, I think, is that anyone with clinical skills should use them effectively ...

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The idea behind surgery is a really simple one: You come to me with a specific problem, I fix it, you go away happy. And when you come back, you're still happy. What's so wrong with that? If I wanted to be miserable, I'd have gone into primary care. When a surgeon screws up, his/her role is clear: Admit it, make it better, or as good as possible, and stick with ...

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asco-logoThe world is a big place and here in the U.S., we are fortunate to live in a part of it where we have access to technology and advanced medical care, clinical trials, and new therapies, even before they are approved by the Food and Drug Administration. Indeed, even new agents approved for one indication can be prescribed off-label in ...

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Recently, I had what I’d call a true banner day in my office. One late afternoon, after I had finished seeing patients, I had started in on that iniquitous pile of paperwork that awaits all of us doctors after office hours. As usual, I was finding the task alternately arduous (can my patient comfortably carry five-to-ten pounds for five-to-ten minutes?), rewarding (the patient does not have lupus), and monotonous (there ...

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Why does is seem that so much information given to us comes with disclaimers? The weight loss product ads on TV that promise more than they will deliver, are always accompanied by 5 nanosecond disclaimers in a font size that can’t be discerned by the human retina stating that the results are not typical. It seems deceptive to be advertising a product by showcasing a performance that the vendor admits is ...

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The doctor-patient relationship is under threat from state laws that try to shape what we can and can’t do for our patients. Many state legislatures are proposing laws that limit the questions doctors can ask patients in our confidential clinic visits. Do you smoke? Drink soda? Exercise? Do drugs? Is there a gun in the home?* Do you want to be pregnant? Is there fracking near your home?* The questions followed ...

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Recently, there was an issue in my O.R. No, the surgery went well. The patient was healthy and tolerated the procedure just fine. And, yes, we had the proper equipment and it all functioned perfectly. This was another kind of issue, something that I had not encountered before. It turned out to be a life lesson. My team and I were getting started in the O.R., for a fairly routine day. ...

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Pamela Wible, MD, a family physician who is an expert in physician suicide prevention, recently asked other physicians why so many in the profession kill themselves. The answers were plentiful, tragic and not at all surprising. One physician confessed to having post-traumatic stress disorder after medical school. Another cited constant sleep deprivation. Yet another mentioned the combination of a crushing workload, a difficult boss and payers who are more worried about ...

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The man who saved more lives than any other physician (in the history of humanity combined) died in a mental institution -- unrecognized and shunned by the medical community. He was beaten by guards and died a miserable death. Dr. Ignaz Semmelweis was a Hungarian obstetrician practicing in the mid-1800s, years before Louis Pasteur came up with his germ theory and Joseph Lister popularized hand washing. While working as an assistant ...

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I received a fax recently, from the office of another hematologist-oncologist, at another academic medical center. Attached to the fax cover page, with my name and fax number scribbled in slanted script, was a five-page consultation report on one of my patients. That oncologist -- I’ll call him Dr. Z -- had seen and evaluated my patient to provide a second opinion on the patient’s diagnosis and treatment. The lengthy report ...

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